Family Therapy

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Family therapy is a type of psychological counseling (psychotherapy) that can help family members improve communication and resolve conflicts.
Family therapy is usually provided by a psychologist, clinical social worker or licensed therapist. These therapists have graduate or postgraduate degrees and may be credentialed by the American Association for Marriage and Family Therapy (AAMFT).
Family therapy is often short term. It may include all family members or just those able or willing to participate. Your specific treatment plan will depend on your family's situation. Family therapy sessions can teach you skills to deepen family connections and get through stressful times, even after you're done going to therapy sessions.
Family therapy can help you improve troubled relationships with your partner, children or other family members. You may address specific issues such as marital or financial problems, conflict between parents and children, or the impact of substance abuse or a mental illness on the entire family.
Your family may pursue family therapy along with other types of mental health treatment, especially if one of you has a mental illness or addiction that also requires additional therapy or rehabilitation treatment. For example:
Family therapy can be useful in any family situation that causes stress, grief, anger or conflict. It can help you and your family members understand one another better and learn coping skills to bring you closer together.
You can ask your doctor or other primary care provider for a referral to a therapist. Family members or friends may give recommendations based on their experiences. You also can ask your employee assistance program, clergy, or state or local mental health agencies for suggestions for therapists.
Before scheduling sessions with a therapist, consider whether the therapist would be a good fit for your family. Here are some factors to consider and questions to ask:
Family therapy typically brings several family members together for therapy sessions. However, a family member may also see a family therapist individually.
Sessions typically take about 50 minutes to an hour. Family therapy is often short term — generally about 12 sessions. However, how often you meet and the number of sessions you'll need will depend on your family's particular situation and the therapist's recommendation.
Say that your adult son has depression. Your family doesn't understand his depression or how best to offer support. Although you're worried about your son's well-being, conversations with your son or other family members erupt into arguments and you feel frustrated and angry. Communication diminishes, decisions go unmade, family members avoid each other and the rift grows wider.
In such a situation, family therapy can help you:
Family therapy doesn't automatically solve family conflicts or make an unpleasant situation go away. But it can help you and your family members understand one another better, and it can provide skills to cope with challenging situations in a more effective way. It may also help the family achieve a sense of togetherness.

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Family therapy is an important means by which to help families understand the development of the disease and address the issues that may be barriers to recovery.
Family Therapy (FT) is a modality of family-based interventions as well as a theoretical lens through which to conceptualize psychotherapeutic interventions. It is based in systems theory and focuses on relationship patterns and the meanings derived from communication within the social and cultural context of human interactions. Traditional FT targets interactional patterns through interventions aimed at improving the organizational structure of families with the goal to modify the behaviors, cognitions, and emotions of its members. Postmodern FT emphasizes the importance of language as a relational vehicle to impact family members’ lives within the cultural context of the community and society at large.
William A. Griffin , in Encyclopedia of Psychotherapy , 2002
Because family therapy does not attempt to modify a person but rather the behaviors exhibited by a system, it is generally applicable to most of the problems seen by mental health practitioners. With children and adolescents, it has been applied to problems ranging from conduct disorder to anxiety and depression. In adults, it has been applied to relationship problems, as an adjunct to the treatment for schizophrenia, depression and anxiety, modifying family reactions to medical illness, and drug and alcohol abuse.
Most of the couples and families treated with family therapy, at least as described in the scientific literature, have been predominantly upper-lower and middle class, and white. In the past decade, greater emphasis has been made to apply these techniques to more diverse groups such as Asian and Hispanic populations. Because family therapy did not evolve from a psychological perspective but rather from a general systems orientation, most of the assumptions that form family therapy are equally applicable across family types and cultures. For example, Salvador Minuchin developed structural family therapy in the early 1960s at a facility that dealt with young delinquents, mostly black and Puerto Rican.
Family therapy is a type of psychotherapy in which the unit of treatment is the family (whether nuclear or extended), and not the individual. It assumes that problems and symptoms emanate from unhealthy interactions in the family system and not solely from the psychological or subconscious problems of the individual. The theory uses circular rather than linear thinking; each individual is part of the larger group, with continuous interaction and feedback processes between the two.
In general, family therapy is based on family system theory. It examines family interactions, interpersonal relationships, and communications and aims to change unhealthy patterns. This theoretical model was introduced in late 1940s and early 1950s, emanating from the study of schizophrenic patients and the link between exaggerations of their symptoms and their family interactions. Family system theory assumes that the family system is in a constant state of change and balance, and it attempts to achieve homeostasis and adaptation to change by mobilizing alternative interactions. When the system can not adapt successfully due to stress, rigidity of patterns, and/or psychological features, problems and symptoms ensue in different members. Consequently, adaptation is inappropriate, and a state of dysfunctional homeostasis settles in.
The early family therapists hypothesized that whenever the family system's homeostasis is threatened, symptomatic behavior in one member may become a way to preserve the family's equilibrium. Therefore, the concepts of scapegoating and the identified patient were introduced.
Early family therapists also hypothesized that many of the preceding phenomena occur through a feedback process and nonverbal communications, through sequence of interactions. At first they attempted to examine the communication of schizophrenic patients and their families, and concluded that there are series of contradictory messages transmitted to the patient. The concept of double bind was introduced, which was considered the essential ingredient in the child–parent interaction, specifically the mother (the concept of the schizophrenogenic mother), in which a family member receives two contradictory messages that he or she can not obey or disobey. Later the concept of double bind was extended from a two-person system to a three-person system, as attention was drawn to fathers as well as mothers. Interactions in the marital relationship were found to be dysfunctional and pathological, and the concepts of schism and skew were introduced. They highlighted patterns of hostility, undercutting, domination, passivity, and distortion.
Other family therapists studied communication patterns and family roles in schizophrenia and identified pseudomutuality as a feature of families with a schizophrenic member. These families appear cohesive on the surface but are in deep conflict underneath. They may also erect a boundary around the family that will extrude any input that will not fit their norm (a rubber fence) and will only allow input that will fit their norm.
These theories were later applied to other family systems with a member identified as carrying a psychiatric diagnosis, such as an eating disorder, depression, or substance abuse. Although all family therapists agree on the basic principle of how a dysfunctional family can lead to stressing a vulnerable member(s) so that symptoms develop and are maintained and amplified, the techniques that have been developed to treat families are quite different from each other. However, each strives to establish a less stressful state in the family.
The length of a course of family therapy is usually shorter than individual therapy, ranging from several sessions to several months. On the whole, the therapist attempts to change the dysfunctional structure and functioning of the system, rather than address changes in the individual member. When therapists attend to symptoms, they are treated as part of a complex system of interaction and feedback processes in which symptoms have become faulty resolutions for other family problems. The therapist strives for a change in rigid behavioral patterns, increased communication, healthier interactions, and improved problem solving among all members.
Major theoretical orientations of family therapy include psychoanalytic (Ackerman), systems (Bowen), structural (Minuchin), strategic (Haley, Madanes), experiential (Whitaker), communicational (Satir, Bateson, Watzlawick), object relations (Framo, Nagy), and a few others, such as constructivist and Milan's system of counter paradoxical family therapy.
Ackerman theorized that a healthy family is in a state of constant homeostatic balance, which is dynamic and changing as the family grows in its developmental stages and as new stresses occur to which the family needs to adapt. The dysfunctional family cannot adapt to the required changes, and therefore the various family functions become faulty and lead to problems and symptoms in its members and possibly to disintegration of the family. Therefore, change can occur through implementing improved problem solving, learning healthier communication, and diminishing the scapegoating of its members.
Bowen developed family systems therapy, theorizing that the basis of human relationships is not a two-person system but a three-person one. He stated that when conflicts and anxiety develop in a relationship, invariably a third person becomes involved who will side with one of the other two. In this threesome, two individuals are close, and the third one is on the outside. This is the basis for the concept of triangles in the family. The triangle may appear to diffuse the anxiety, but conflicts remain unresolved.
Triangles are constantly shifting and unstable and have a tendency to interlock with other triangular relationships. Individuals learn from their family of origin how to operate in triangles. When the adaptive level of functioning in a family is pathological, the individuals in that family are more likely to resolve anxiety with triangulation and are less differentiated. The concept of triangles and triangulating was later applied to larger systems such as organizations and small groups.
Bowen stated that each family is part of an undifferentiated ego mass, and each member strives to differentiate from it, to develop one's own sense of self, and to detriangulate oneself. He also stated that patterns of relationships and handling stress are a part of a process that is transmitted across generations. When getting caught in triangulated relationships with their family becomes too intense and stressful, members may try to distance themselves emotionally or physically, or they may try to cut themselves off from the family. However, similar patterns will be recreated and repeated in other relationships that the individual develops.
This model also introduced the concept of family projection process, which means that the emotional processes are transmitted, for example, to a child, who as a result may develop difficulties in differentiation of self.
The family system theory of Bowen states that historical patterns are factors in symptom production as well as change; therefore, the main tool of treatment is using a genogram or diagram of the family's three generations in detail, demonstrating sets of relationships, conflict areas, and triangular relationships, and then exploring methods of unlocking and changing them. Bowen encouraged families to resolve issues with their families of origin and attempt to achieve separation and differentiation from them.
The goal of treatment is understanding the three-generation system of invo
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